You know the type—always rushing, always impatient. Maybe you're one of them. To describe this aggressive species, cardiologists Meyer Friedman and Ray Rosenman in 1974 popularized the term Type A in their best-seller, Type A Behavior and Your Heart. The book suggested that an overloaded life-style can lead to coronaries. Now Friedman, 74, has a new book, Treating Type A Behavior—and Your Heart (with Diane Ulmer, RN; Knopf, $15.95). He talked to San Francisco Bureau Chief Nancy Faber about his Recurrent Coronary Prevention Project and the Meyer Friedman Institute at the city's Mt. Zion Hospital, and how Type A behavior may be modified.
What is Type A behavior?
Its hallmarks are aggravation, irritability, anger and impatience. Type A individuals are insecure, hyperaggressive or both. Their hostility is easily aroused, and they are driven by a sense of time urgency, a continuous struggle to fit more and more activities into less and less time.
How common are Type A personalities?
Ranging from mild to severe forms, I would say more than half of all American males in cities are Type As.
What made them that way?
At the root is the failure to receive unconditional love and encouragement in early childhood from one or both parents. For some Type As, however, this damage to their self-esteem came from a lack of acceptance by their peers as they were growing up.
Who would be an example of a Type A ?
Lyndon Johnson comes to mind as an extreme case. He was very insecure and given to outbreaks of hostility over trivialities. He was a hurried man; there were three TV consoles in his White House bedroom so he could watch more than one channel at a time. Johnson was very concerned with numbers—the body count in Vietnam, the number of eggs laid by the chickens on his ranch, how many postcards were sold at his birthplace—a classic Type A preoccupation.
Can Type As ever be satisfied?
Their expectations are gargantuan. I know a Nobel laureate who is Type A. You'd think he'd be satisfied, but he feels, well, his prize is 25 years old and not as important as later prize-winning discoveries. And besides he hasn't been elected to the board of the symphony in his town.
But isn't that a quality that produces society's greatest achievers?
Absolutely not. That's a myth that needs debunking. Type A personalities who succeed do so in spite of their impatience and hostility. For a book I am doing on the rich and powerful in America, I interviewed 11 Nobel prizewinners. Six of them were Type As, but five were Type Bs.
Are Type Bs usually the opposites of Type As?
Yes. Type Bs have a fundamental sense of security and self-esteem. They are not contemptuous of others because they have no self-contempt. Instead, they feel sorry if people don't do things right. Type B individuals can get angry if it's important, but they don't let what I call "trash events"—things not worth getting upset about—bother them.
Such as other motorists?
Yes. About 95 percent of our Type A coronary patients have trouble driving a car. Type A has a perfect idea of how traffic should flow. He's easily irritated by the traffic manners of other drivers. They are not doing it exactly right.
Who are some examples of Type Bs?
President Reagan has the Type B pleasantness; he emanates good will. Among other Presidents, Lincoln, Truman and Ford can be classified Type B, while Kennedy was Type A. General Patton was a Type A, but Omar Bradley was a B.
Are your A and B classifications applicable only to men?
Oh, no. We see more and more Type A women as they begin working under the same kind of stress as men. Black women in two separate studies in the 1950s had as much heart disease as men. Why? Because they often were the working heads of the family. Women tend to be more subdued in their hostility, although they now are encouraged to be more openly aggressive.
Is it your position that Type A behavior is a primary cause of coronaries?
Because of a cholesterol-rich diet, most Americans have plaques in their arteries by their mid 20s. Nothing in our later diet, and no exercise, can make it go away. The plaques grow and without enough blood supply they decay. We believe that Type A behavior accelerates the growth and decay of plaques, which then rupture, leading to blood clots and heart attacks.
Is cholesterol the main culprit?
The results of diet are already established by adulthood. After that, your behavior—how you react to your environment and its challenges—plays a far more important part in bringing on a heart attack than what you eat or how you exercise.
Do Type A individuals acknowledge their behavioral problems?
About half absolutely deny them. We say that even if you have just one or two Type A traits, you're suspect. If you are truly irritable in traffic, if your wife has to tell you to cool it, if you get upset in a restaurant when you have to wait, you are a Type A.
What were the objectives you hoped to achieve by the three-year study that led to your new book?
To see if we could modify Type A behavior in people who have had one or more heart attacks and, if so, whether a change in the behavior of these former patients could protect them from future heart attacks.
Who were your subjects in the study?
We began with 862 Type As and divided them randomly into two groups. The first group of 592 received special counseling while a control group of 270 was given only the usual post-coronary instructions about diet, exercise and medication. We had engineers, taxi drivers, housewives, chief executive officers, postal workers, rabbis, judges. They had to be 65 or under, not diabetic, and nonsmokers for at least the past six months. Ten percent were women and more than 50 percent had college degrees. About two-thirds of each of the two groups finished the three-year study.
What were the results?
Very promising. Heart attacks among those who were counseled to change their behavior recurred at the rate of 7.2 percent over a three-year period compared to 13.2 percent for the control group. And 79 percent of those who received special counseling showed reduced levels of AIAI, the acronym we use for aggravation, irritability, anger and impatience.
Can you measure "changed behavior?"
An independent consultant interviewed and videotaped each person at the beginning of the program and again three years later. She looked for the classic signs of struggle: fast blinking eyes, clenched fists, too-quick answers, a strangled voice, sighs when speaking, facial grimaces. When you compare the videotapes, anyone can see the differences. We also asked each person to evaluate himself or herself and gave questionnaires to spouses or a business associate or friend for independent evaluations.
How did you get them to change?
They all believed that Type A behavior helped them get ahead in life and in their careers. We helped them to see that, in reality, AIAI was the cause of most of their unhappiness—lost job opportunities, divorces, estranged children. Then they had to learn how these destructive patterns could be changed. We taught them to behave in ways that many of them had forgotten: telling family members that they are loved, cultivating friendships that have nothing to do with business, allowing time each day to do nothing.
Sounds easy. Was it?
Not at all. They had to do homework every day for three years and bring in a checklist. Monday's task might be "Drive in the slow lane;" Tuesday, "Practice smiling;" and so forth. The hardest lesson for Type As is not to get angry at other people's little faults.
With practice, can Type As be totally transformed?
No. You can't change personalities. We just try for more B-like behavior.
Are you a Type A?
Yes. I had a heart attack when I was 55. I used to be called "Cannonball" for speeding down halls, as if patients would evaporate before I got there. If people didn't talk fast enough, I'd go "Yup, yup, come to the point." I'd get fussed about things; my way was the right way. But I knew about Type A, and I did slow down. Now I don't mind going to the supermarket and waiting in line. In fact, I kind of enjoy it.
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